Dying At Home In Chiang Mai

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I recently lost my very good friend. She died of cancer at home here in Chiang Mai. Her son came from the U.S. to spend her last weeks with her and I promised him that I would post this information to help others deal with the particulars while they are having to deal with the pain of loss. Because, as the terminal diagnosis became an unavoidable reality we began to try to find information on what procedures should be followed when a falang dies in Chiang Mai. There was very little information to be found. The following is our experience of the steps to take following a death at home. ( One day, I hope to put some information regarding the whole treatment experience but that is for another time).

The evening my friend passed away her son called for an ambulance from Chiang Mai Ram (where she had been under the care of an oncologist). The ambulance arrived but, as she had already passed, they said that the police must be called first as it was a death outside of the hospital. The ambulance then returned to CMR. When the police arrived there was a lot of confusion. Luckily a Thai friend stepped in and explained that the deceased had been very ill with cancer for a long time. (At this point and from now on it is very important to have the passport of the deceased.) The police asked her son if he wished for an autopsy to determine if it was actually the cancer that had killed his mother. He declined. The police took a report and took a picture and allowed the son to call for another ambulance. The ambulance transported the deceased to the hospital and allowed the son and me to ride with the body.

At the hospital the body was placed in a refrigerated unit in the morgue (quite a small, informal area). The son was advised to contact the police to pick up the police report in the morning (the hospital verified which police station to go to) and then to contact the British Honorary Consulate (she was British). We were offered a ride back to our homes.

The police report was quickly obtained for no charge. We then went to the British H. Consulate where the son was treated with great kindness. The son had a birth certificate showing that he was next of kin. He was asked if there were any other relatives that should be involved with funeral arrangements. Copies were made of passports, birth certificate, and the police report. A letter was typed certifying that the son was the next of kin and was able to make funeral arrangements. He was advised as to which municipal office he needed to proceed to in order to get a death certificate. It must be the office in charge of the area in which the person died. There was no charge for any of this.

We encountered our first small glitch at the municipal office. The forms are in Thai and you will need someone who can read and write Thai to help you fill them out. We were very lucky as a young woman on her break from work offered to help. The death certificate was obtained in a short time and copies made.

The next step was to go to the temple. We had chosen Wat Pa Paeng. We had not spoken to anyone officially before this, however, as they won't make arrangements without the death certificate. By now we had been joined by a friend who speaks fluent Thai. (Very necessary at this point.) There was a Thai gentleman at the wat who spoke with us and within 30 minutes the arrangements had been made for a simple Buddhist cremation for the following afternoon. The price for the ceremony was 5,000 baht to be paid in an envelope before the ceremony. Another 200 baht would be paid when the remains were picked up on the morning following the funeral.

We then proceeded to the hospital where we made arrangements for an ambulance to take the body to the wat the following afternoon. We also requested to have a change of clothes put on the body. This was all arranged easily. However, if you bring a change of clothing be sure that the items have buttons or closings that allow it to be put on a stiffening body, Sliding clothing over the head or feet may not work.

At the appointed time the following day we arrived back at the hospital and paid a small fee for the all of the hospital services (several ambulance rides and storage in the morgue, 600baht).The body was wrapped in a white sheet and we accompanied it in an ambulance to the wat. The body was placed on a wooden tray. Monks chanted and performed a simple ceremony. Family and friends were allowed to place flowers (usually wreaths in Thailand) on the body and to say good-bye. The crematorium was opened and the body was slid inside. After waiting for the boy and girl scouts who were practicing drills in the temple yard to finish, the crematorium was lit. The ceremony was over and the friends and family retired to a local café to tell stories and toast the deceased.

The following morning we returned for the remains. Thinking that the son would be given ashes with bits of bone we were surprised to be greeted with a pile of bone on a metal tray. Some pieces were longer than 10cms. Later we learned that it is the bones that are important to the continuing ceremonies for many Asian cultures. If you want some ashes you may be able to arrange something different before the ceremony but I don't know if they are equipped to gather the ash. We were given a plastic bag to collect the bones by hand. We were instructed to wash our hands after doing this. The son was given a receipt from the wat for the bones.

Before leaving the country the son was advised to get the death certificate, the police report, and the receipt for the bones translated into English. This can be done through the consulate but that entails days of waiting and piles of baht. He was able to use a local translating service. He was advised to hand carry the remains along with the proper paperwork. He was not questioned upon leaving Thailand or entering the U.S. so the validity of the paperwork was not called into question. .

All that remains now are the memories and the hole on the soi where this wonderful woman resided. She is missed on many continents. It would be her wish that her death could be informative to others. In death, as in life, she is an inspiration.

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I am going to pin this topic & if the op doesn't mind amend the subtitle to "Information on what to do for next of kin"

I am just learning how to work this forum so I hope this is the correct way to respond.

Of course, please change the subtitle if that will make the information more accessible. My friend who passed away was big into getting information out. She wrote several books over the years that were quite useful so this is all in her name.

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TRAZ57, are you able to tell us much about how the woman's pain management was handled?

I think that is something of much concern to all of us; for ourselves as well as for others.

When I can get my head together I will write about the treatment she recieved. I wish that I could say that pain management was sufficient, but it was not. Her son was able to bring some prescription drugs from the states that helped some. The doctor here was willing to prescribe some morphene but in small amounts. There is strong paranoia regarding morphene here, as if terminal patients can become addicts!

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... snip ... There is strong paranoia regarding morphene here, as if terminal patients can become addicts!

Sawasdee Khrup, Khun TRAZ57,

Let me join in with other TV members who have thanked you for this post, and I am sorry to hear of your loss; at the same time, I feel very appreciative that your late friend had friends, like you, who took care of the final arrangements with such concern.

For your information : I had no trouble whatsoever getting Fentanyl transdermal (skin) patches during the intensely painful period following radiation therapy which lasted about six weeks. I was treated at the cancer clinic at Sripat within the Maharaj hospital complex on Thanon Suthep. Dr. Loavicharn, at Sripat, is perhaps Thailand's leading oncologist, and is American educated and board certified. His "number two" is a brilliant young Thai woman who went to Stanford, Harvard (M.D.), and then Johns Hopkins for oncology training and board certification. In my opinion I got much better care at Sripat with these doctors than I would have ever gotten in the US (unless I had a fabulous fortune to spend at some place like the M.D. Anderson Cancer Center).

is a synthetic opioid perhaps eighty or more times more powerful than morphine : the skin patches, in varying strengths, allow a small amount to infuse into the body slowly, and constantly, over time. While I personally am highly, and negatively, reactive to opiates (side effects for me include itching, restlessness, and subjective feelings of being on a "caffeine high"), these effects (which led me to "shun" using morphine in the case of both a hip replacement and, years later, recovery from a badly fractured leg), were not so dramatic on Fentanyl.

I hope this information will be useful to you, or someone else here on TV.

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"For your information : I had no trouble whatsoever getting Fentanyl transdermal (skin) patches during the intensely painful period following radiation therapy which lasted about six weeks.

I hope this information will be useful to you, or someone else here on TV." orang37

Thank you. I wish that we had known of this medication. I am sure that someone will benefit from your post, especially your recommendations for an oncology doctor and the cancer clinic. (Can my friend have a "do over"?) Best wishes with your health. T57